List members,
I am forwarding this from another mail list with the thought that you may
wish to be aware of the apparent provisions of this bill. Can anyone expand
on this?
John Roraback, Ph.D.
----------- forwarded message ----------------
Subj: Hazard to Fee-For-Service Care?
Date: 96-05-31 23:24:18 EDT
From: jordanr@CREATIVE.NET (Jordan Rosenberg)
Wall Street Journal 5/30/96 p. A14
Jane Orient finds the following provisions in the already passed House and
Senate versions of the Kassenbaum-Kennedy bill:
5 years in prison for making a misstatement to your health plan (eg, failing
to mention a pre-existing condition)
10 years in prison for intentionally misapplying any assets of the plan to a
medically unnecessary service even if it helps you
5 years in prison for failing to turn over to a prosecutor the patient's
records, even if it is you being prosecuted.
Life in prison if a plan is defrauded in connection with a patient who dies
(no mention of whether the fraud contributed to the death)
$10000 fine for each instance of incorrect coding, even if honest mistake
Fine or prison for those who transfer items for free or less than fair value
(providing charity)
Automatic seizure of property bought with money tainted by these offences.
Paid informants; prosecutors keep fines and seized property
Dr. Orient contends this makes health care very risky. However, the risk is
only for providers in private practice. Those who work through an HMO are
exempt. So is the HMO. If it does wrong it need only provide a plan of
correction.
I haven't seen the legislation but if the article is right it sounds
devastating for fee-for-service practice. None of this is being debated,
perhaps very few people know, and it should be addressed before the bill
becomes law.
Jordan Rosenberg
jordanr@creative.net